When the Rules Do not Work: Head Injury Without Loss of Consciousness

Abstract

p t r. Joshua Easter: Today’s case is a 24-year-old man ho presented to the Emergency Department (ED) with nkle pain and headache after a snowboarding accident he day prior. The patient recalled that he was snowoarding down a slope and caught the opposite edge of is snowboard on the snow, causing him to fall backards, and he hit his helmeted head against the snow. he patient stated that he did not lose consciousness, and e was able to recall the details of the event. He noted mmediate onset of pain in his left ankle, but he was able o bear weight on the slope. About an hour after the ccident, he noticed that he had bitten his tongue and had mild occipital headache; however, he was still able to ontinue snowboarding for 3 more hours. The headache, escribed as mild in nature, persisted until his presentaion to the ED the next day. He denied nausea, vomiting, ethargy, or focal weakness. The pain in his ankle was escribed as severe, sharp, and exacerbated by flexion of he ankle. He denied knee pain or other discomfort. Dr. Jonathan Edlow: Patients with head injury may e unreliable in reporting the details of the injury, paricularly whether there was loss of consciousness. Was his episode witnessed? Dr. Easter: The patient’s snowboarding companion, ho accompanied him in the ED, confirmed that there as no loss or alteration of consciousness after the imact. The companion also confirmed that this was a round-level fall and that the patient appeared normal fter the incident. No abnormal motor activity was noted. Dr. Shamai Grossman: Can you further describe the atient’s headache? Dr. Easter: The headache was dull, generalized, and eveloped gradually in the hours after his accident. There ere no exacerbating or alleviating factors. On examit